A Plant Powered Diet for Optimal Health - Sharon Palmer, RDN, MS The Plant Powered Dietitian - Nestlé Medical Hub
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A Plant‐Powered Diet for Optimal Health
Sharon Palmer, RDN, MS
The Plant‐Powered Dietitian
Duarte, California
Presented on August 22, 2019
Financial Support for this presentation was provided by Nestlé Health
Science. The views expressed herein are those of the presenter and do not
necessarily represent Nestlé’s views. The material herein is accurate as
of the date it was presented, and is for educational purposes only and is
not intended as a substitute for medical advice. Reproduction or
distribution of these materials is prohibited.
© 2019 Nestlé. All rights reserved.
“Fall in love with
plants and they
will love you
back,” Sharon
Palmer, MSFS,
RDN, Plant-
Powered for Life
There are 40,000 edible species of plants on the
planet, each with the power to nourish and help heal
our bodies; each plant has its own story. There are
25,000 types of tomatoes alone!
Photos and recipes by Sharon Palmer, MSFS, RDN
Objectives
1. Identify health benefits
associated with plant-based
diets.
2. List plant proteins that can
replace animal proteins.
3. Synthesize strategies for
helping people eat a plant-
based diet.
4. Review how to incorporate
plant-based tube feeding
formulas for those who are
unable to eat by mouth.
Photos and recipes by Sharon Palmer, MSFS, RDN
Plant-Based Eating Is Breaking News
Plant-Based Eating is Hot, Hot, Hot!
• 24% consumers eat more plant
protein than previous year
(IFIC, 2019).
• Estimated $140B market for
alternative meat in 10 years
(Marketwatch, 2019).
• Impossible Burger going
nationwide at fast food
restaurant, such as BK.
• Veganism on the rise: 11% of Gen
Z, 10% of millennials
(Hartman, 2017).
• Two-thirds of U.S. consumers say
they are eating less meat (Johns
Hopkins Center for a Livable
Future, 2018).
Spicy Sorghum Sweet Potato Veggie Burgers
Photos and recipes by Sharon Palmer, MSFS, RDN
Eat food.
Not too much.
Mostly plants.
Michael Pollan
In Defense of Food
Cauliflower Spinach Lasagna
Photos and recipes by Sharon Palmer, MSFS, RDN
Plant-Based Diet: Hits Best Diet List
Plant-based diets are good for the
“ environment, your heart, your
weight and your overall health.
U.S. News defines plant-based as
an approach that emphasizes
minimally processed foods from
plants, with modest amounts of
fish, lean meat and low-fat dairy,
and red meat only sparingly. ”
US News Best Diets in 2019 Expert Panel
Even 2015-2020 Dietary
Guidelines More Plant-Based
• Focused on plant-based
diet patterns:
– Mediterranean
– US Healthy Diet
Pattern
– Vegetarian
• Limit saturated fat
• Eat more fruits and
8-Minute Zucchini Tomato Basil Sandwich vegetables
• Include more pulses
Photos and recipes by Sharon Palmer, MSFS, RDN
Plant-Based Diet Part of Blue Zones • People live the longest • Eat a plant-based diet • Sense of community • Exercise Classroom in Japan
Plants are Part of
Indigenous, Traditional Diets
• Common Features:
– Local whole
grain
– Local legumes
– Seasonal Quinoa in Sacred Valley, Peru
cultivated and
foraged fruits
and vegetables
– Seeds and nuts
– Minimally
processed Kyoto, Japan
– Low use of Farmers Market, Thailand
animal foods
Photos and recipes by Sharon Palmer, MSFS, RDNWe Have Moved to Western Diet
• High in animal foods,
highly processed foods,
fast foods
• High in sugars, sodium,
saturated fat
• Low in fruits, vegetables,
whole grains, legumes
Deep-fried donut bacon cheeseburger with fries
• Low in fiber, vitamins,
minerals,
phytochemicalsPlant-Based Eating Has it All
One eating style with
so much power:
• Environmental
benefits
• Health benefits
• Animal welfare
benefits Plant-powered eating with my family
• Solution for feeding a
growing population
Photos and recipes by Sharon Palmer, MSFS, RDNRise of Meatless Monday
Showing Support:
• Organizations, hospitals,
schools, universities,
restaurants, and more
• Stars lining up, from Tom
Hanks to Rita Wilson
• Key influencers, including
Michael Pollan
Associated with Johns Hopkins’
Bloomberg School of Public Health • Chefs, like Bryce Shuman
of Betony, and Anthony
Lamas of SevicheDefinition of Plant-Based Diets
Vegan
No animal foods
Lacto-Ovo Vegetarian
Definition of No animal flesh, but allows
a plant- for dairy and eggs
based diet is
one that
focuses on Pescatarian
plants No animal flesh, except for
fish and seafood
Semi-Vegetarian or
“Flexitarian”
Small amounts of animal foodsEnvironmental Benefits of
Plant-Based Eating
• Lower carbon footprint:
compared to non-vegetarians,
lower by 20% semi-vegetarian;
24% pescetarian, 28% lacto-
ovo, 42% vegan (AHS-2)
Sesame Udon Salad with Snow Peas
“Nothing will benefit human
health and increase chances
for survival of life on Earth as
much as the evolution to a
vegetarian diet.”
Albert Einstein
Sesame Tempeh Buddha Bowl
Photos and recipes by Sharon Palmer, MSFS, RDNPlant-Based Eating Patterns:
Better Eco-Impact
• Reducing livestock production by
50% in EU will reduce greenhouse
gas emissions (GHGE) by 25-40%
(Global Environmental Change)
• Plant-based diet reduced GHGE
72%, land use 58%, energy
consumption 52%, water
consumption 33% in Spain,
compared to Western diet
(Environmental Health Journal)
• Reducing animal products saves
water resources; up to amount
needed to feed 1.8 billion additional
people globally (IOP Science)
Carrot Cake Overnight Oats
Photos and recipes by Sharon Palmer, MSFS, RDNPlant-Based Eating Patterns:
Better Eco-Impact
• Person consuming average
diet releases 701 kg of CO2
per year more than
emissions of person
consuming only plants
(Earth Interactions)
• Legumes most efficient
protein source: 1 kg
protein=18X less land, 10X
less water, 9X less fuel, Arugula Salad with Radishes and Avocado and Truffle Vinaigrette
12X less fertilizer, 10X less
pesticides than beef
(Public Health Nutrition)
Photos and recipes by Sharon Palmer, MSFS, RDNPower Up on Sustainable Pulses
Low Carbon Footprint: one of the
lowest of any food group
Drought Tolerant: can grow in harsh
environments with lower water use
Natural Fertilizer: enrich the soil
through fixing nitrogen, reducing need
for fertilizers
Aids Food Security: half of production
occurs in developing nations
Increases Crop Diversity: decreasing
risks to farmers
Feeding the World: need 70% increase
Fresh chickpeas, farmers market, Crete
in agricultural production by 2050
Economical: 10 cents per serving
(Food Policy)
Photos and recipes by Sharon Palmer, MSFS, RDNPlant-Powered Eating
Has Health Benefits
“ Appropriately planned vegetarian, including vegan, diets are
healthful, nutritionally adequate, and may provide health
benefits for the prevention and treatment of certain
diseases…appropriate for all stages of the life cycle…more
environmentally sustainable than diets rich in animal
products…Vegetarians and vegans are at reduced risk
of…ischemic heart disease, type 2 diabetes,
hypertension, certain types of cancer, and obesity. Low
intake of saturated fat and high intakes of vegetables,
fruits, whole grains, legumes, soy products, nuts, and
seeds (all rich in fiber and phytochemicals) are
characteristics…that produce lower total and low-density
lipoprotein cholesterol levels and better serum glucose
control.
Position, Academy of Nutrition
and Dietetics, 2016
”What’s So Great About Whole,
Minimally Processed Plant Foods?
• High in the “good” stuff:
– fiber, vitamins, minerals, healthy
fats, phytochemicals, low
glycemic carbs
• Low in the “bad” stuff:
– saturated fat, dietary cholesterol,
sodium, toxins (nitroso
compounds, heterocyclic amines,
polycyclic aromatic
hydrocarbons, glycation end
products formed in cooking,
curing, processing meats)
Green Bean, Chickpea, and Farro Salad with Za’atar
Photos and recipes by Sharon Palmer, MSFS, RDNPhytochemicals Galore
• Filled with thousands of phytochemicals
• Most Americans fall short
• Get our “colors” from yogurt and cheese puffs
Pike Place Market, Seattle healthyschoolfood.org (Accessed 0819)
Photos and recipes by Sharon Palmer, MSFS, RDNMany Health Benefits of Plant-Based Diets
Longevity
Healthier Weight
Lower Oxidative Stress and
Inflammation
Reduced Risk of Heart Disease
Reduced Risk of Type 2 Diabetes
Lower Risk of Some Cancer
Zucchini Oat Veggie Patties
Healthy Gut/Immune System
Brain Protection
Photos and recipes by Sharon Palmer, MSFS, RDNLongevity • EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition), more closely adhered to plant-based diet, longer lifespan (Public Health Nutr). • Vegetarians: 12% lower risk of dying over the study period compared to meat eaters; vegans 15% lower (JAMA Intern Med). • Diets with higher amount of protein from plants linked with lower mortality (Am J Kidney Dis). • High animal protein linked with increased mortality; sub plant protein lower mortality (JAMA Intern Med).
Healthier Weight
• Patients assigned to vegan or • EPIC study, BMI fish eaters,
vegetarian diet lost vegetarians, and particularly
significantly more weight vegans lower than meat eaters
(Int J Obes Relat Metab Disord)
over 2 months than those Example: 55 year old male or female
omnivorous diet — about 5% of vegan weighs 30 pounds less than
body weight compared with a non-vegetarian of similar height.
2% loss.*
• Vegan diet most effective in
*Randomized trial, not isocaloric weight loss among 5 diet patterns,
vegetarian, pescatarian, semi-
vegetarian, and omnivorous
(Nutrition).
• Meta-analysis: Med diet may be
useful for weight reduction
(Metab Syndr Relat Disord).
• Review: Flexitarian diet weight
and metabolic benefits (Front
Nutr).
Radishes at farmers market Photos and recipes by Sharon Palmer, MSFS, RDNPlant-Powered Eating
Blood Orange Hazelnut Kale Salad Tortilla Soup Thai Tofu Veggie Noodle Bowl
Photos and recipes by Sharon Palmer, MSFS, RDNLower Oxidative Stress &
Inflammation
• Studies show high intake of whole
plant foods, such as fruits,
vegetables, whole grains, nuts, tea,
coffee, red wine and olive oil,
decreases levels of oxidative stress
and inflammation, which are associated
with the development of chronic disease
(Am J Clin Nutr, 2006, J Am Coll
Cardiol).
Rainbow cauliflower at farmers market, Davis, CA
• In Adventist Health Study II, vegetarian
diet linked to lower CRP levels, a
marker of inflammation (Ethn Dis).
• Framingham Heart Study, higher intakes
of anthocyanins and flavonols linked with
reduction in oxidative stress
biomarkers (Am J Clin Nutr).
Photos and recipes by Sharon Palmer, MSFS, RDNReduced Risk of Heart Disease
• The risk of hospitalization or
death from heart disease is
32% lower in vegetarians than in
people who eat meat and fish,
according to a British study (Am J
Clin Nutr).
• Meta-analysis, 25% reduced risk
of ischemic heart disease with
vegetarian and vegan diet
(Crit Rev Food Sci Nutr).
• Several studies show heart
benefits, possibly due to lower
inflammation, oxidative stress,
blood pressure, LDL levels (Am J
Clin Nutr).
• Veg diet linked with more
favorable CVD biomarkers,
vascular function (Int J Cardiol).
Mediterranean Edamame Quinoa Bowl
Photos and recipes by Sharon Palmer, MSFS, RDNLower Risk of Type 2 Diabetes
• Red meat linked with higher risk type
2 diabetes, but when one serving
swapped for nuts every day,
decreased risk by 21%,
substituting whole grains
reduced risk by 23%
(Am J Clin Nutr).
• Meat-eaters significantly higher risk
of developing diabetes,
compared with people who
avoided meat (Nutrients).
• Vegetarian diet patterns linked with
lower Metabolic Syndrome, and
lower risk of developing type 2
diabetes (Br J Nutr).
• Review from Canadian Diabetes
Association: Plant-based diets
beneficial in management of
type 2 diabetes (Can J Diabetes).
Heirloom Bean Cassoulet with Root Vegetables
Photos and recipes by Sharon Palmer, MSFS, RDNPlant-Powered Eating
French Lentil Green Salad Squash Filled with Herbed Indian-Style Yellow Lentil Stew
with Cherry Tomatoes Quinoa and Cranberries
Photos and recipes by Sharon Palmer, MSFS, RDNLower Risk of Cancer
• Meta-analysis, 8% reduced risk
of total cancer with
vegetarian and vegan diet
(Crit Rev Food Sci Nutr).
• Plant foods linked with
protection against mouth,
pharynx, esophagus,
stomach, lung, pancreas, and
prostate cancer; in particular,
high fiber plant foods may
protect in digestive cancers
(AICR).
• Study linked plant-based diet to
20% lower breast cancer risk
(Am J Epidemiol).
• Vegetarians 22% lower risk
colorectal cancer Farmers market, Nashville
(JAMA Intern Med).
Photos and recipes by Sharon Palmer, MSFS, RDNWorld Cancer Research Fund
Cancer Prevention Recommendations
• Be as lean as possible without becoming • Limit consumption of
underweight. red meats (such as
• Be physically active for at least 30 beef, pork and lamb)
minutes every day. and avoid processed
• Limit consumption of energy-dense foods. meats.
• Limit alcoholic drinks
• Eat more of a variety of vegetables,
• Limit consumption of salt
fruits, whole grains, & pulses, such
& avoid moldy grains and
as beans.
cereals.
• Don’t use supplements to
protect against cancer.
• It is best for mothers to
breastfeed exclusively for
up to 6 months and then
add other liquids and
foods.
Farmer’s market, Thailand Photos and recipes by Sharon Palmer, MSFS, RDNHealthy Gut & Immune Function
Increasing evidence fiber-rich,
plant-based diet promotes
healthy gut microbiota, linked
to immune support and digestive
health
• Vegan gut profile: reduced
pathobionts (disease-
causing organisms),
increased protective species
(Nutrients).
EPIC study, lower rate of
Plums at the farmers market
hospital admissions, risk of
death from diverticular
disease in vegetarians (BMJ).
• Mediterranean diet beneficial
for gut microbiota (Gut).
Photos and reicpes by Sharon Palmer, MSFS, RDNBrain Function
• Chronic inflammation and
oxidative stress lead to
development of Alzheimer’s
disease (AD).
• Adherence to
Mediterranean, plant-based
diet linked with lower risk of
AD (Arch Neurol).
• 7 Dietary and Lifestyle
guidelines to reduce risk of
AD:
• Minimize saturated and trans
fat
• Eat plant-based foods
• Consume 15 mg vitamin E
from foods each day
Apples fresh from the garden
(Neurobiol Aging)
Photos and recipes by Sharon Palmer, MSFS, RDNAdventist Health Study-2
96,000 adults
5 diet patterns
(non-vegetarian, semi-vegetarian,
pescetarian, lacto-ovo vegetarian,
vegan)
Showed overall linear
relationship: BMI, HTN,
type 2 diabetes, elevated
total cholesterol, CRP,
insulin, overall cancer,
mortality, carbon
footprint
Vegan Tamale Pie
Photos and recipes by Sharon Palmer, MSFS, RDNAHS-2: Relative mean food intake of vegetarian
groups compared to non-vegetarians
Food consumption
differs substantially
across dietary patterns
• Vegetarians consume
greater plant foods and
reduced amounts of
sweets, added fats, non-
water beverages, and
animal foods as
compared to non-
vegetarians
Sabate J, Wien M. Am J Clin Nutr.
2010;91(5):1525S‐1529S.
Sabaté J, Wien M.. Br J Nutr.
2015;113(2):S136‐43. doi:
10.1017/S0007114514004139.Developing a Plant-Based Eating Style
include more plant proteins:
Legumes (beans, lentils, and peas)
Whole soy foods (tofu, tempeh, soy milk)
Nuts and nut butters (almonds, walnuts, hazelnuts, pecans, pistachios,
macadamias, Brazil nuts, peanuts)
Seeds and seed butters (sunflower, sesame, hemp, chia, pumpkin)
Whole grains (quinoa, oats, brown rice) can be good protein source (up to 11 g
protein per cup, i.e. Kamut, wheat berries)
Vegetables, such as peas, spinach, broccoli (can contain up to 6 g protein per
cup)Oldways
vegetarian
& vegan diet
pyramid
Use with permissionLaws Enacted for Plant-Based
Meals Requirement
• CA signs law (SB 1138)
making state first to require
prisons, hospitals, nursing
homes, and other state-
operated facilities to offer
plant-based meals (no
animal products).
• NY state law (S1471) passed
requiring hospital patients
plant-based options.
• It’s Happening! Bellevue
NYC Plant-Based Lifestyle
Medicine Program (plant-
based doctor, RD, coach)
Use with permissionSupport for Plant-Based Hospital Food
• In 2017, AMA adopted resolution calling
hospitals to align their menus with their
health care mission and to “improve the
health of patients, staff, and visitors by
providing a variety of healthful food,
including plant-based meals and meals
that are low in fat, sodium, and added
sugars, eliminating processed meats from
menus, and providing and promoting
healthful beverages.
• 57% of hospitals serve less meat than
previous years
• 82% of hospitals purchase locally
produced foods
• 20% of hospitals have farmers markets,
gardens, produce prescription, and/or
community supported agriculture (CSA)
programs (Health Care Without Harm)
• Cool Food Pledge (HCWH): reduce GHGE
Herbed Lentil Patties with by 25% by 2030, increase plants and
Mushroom Sauce
reduce animal foods.
Photos and recipes by Sharon Palmer, MSFS, RDNPlant-Based Trends in Tube Feedings
• We’ve come full circle from the old
days of blenderized tube feeding
formulas to synthetic formulas
and back to foods in tube feedings.
• Offer plant-based options for
patients, even for those who are
tube-fed.
• Families want to provide real,
plant-based foods for tube-fed
members, especially for children
long-term.
• Want to feel “normal”, “healthy”,
and “real”.
• Follows right along with
mainstream eating trends, for
“clean”, organic, plant-based
eating.
• Desire real foods in tube feedings,
such as fruits, vegetables, nuts,
grains, pulses.
Photos and recipes by Sharon Palmer, MSFS, RDNPlant-Based Tube Feeding Options
New plant-based formulas available, such as:
– Functional Formularies® Liquid Hope®: Organic
garbanzo beans, green peas, carrots, brow rice, flax oil,
quinoa, sweet potato, broccoli, almond butter, kale,
garlic, turmeric, rosemary, ginger, seaweed, vitamin
blend.
– Kate Farms® : Pea protein formula with phytonutrients,
includes brown rice syrup, sunflower oil, inulin, flax
seed oil, quinoa flour, chia, with added vitamin and
minerals.
– Nestlé Health Science Compleat® Organic Plant-Based
Blends: Blueberries, kale, pears, sweet potatoes, brown
rice flour, pea protein, cinnamon and ginger, with added
vitamins and minerals to meet age-appropriate DRI
(distinct formulas for adults and children).
– Real Food Blends®: Quinoa, kale & hemp: Grape juice,
kale, hemp, olive oil, quinoa, cinnamon.
Functional Formularies and Liquid Hope are registered trademarks of Nutritional Medicinals, LLC.
Kate Farms is a registered trademark of Kate Farms Inc.
Real Food Blends is a registered trademark of Real Food Blends, LLC.Positive Vibes for Real Food,
Plant-Based Feedings
• Well received by health care professionals
(RD, MD, RN), caregivers, families.
• Use in healthcare setting, as well as, home
care setting.
• Provides synergistic benefits of whole
plants.
• Survey shows HCP like for ingredient list,
better tolerance, failure with other formulas,
improved diarrhea/stools, improved pro/cal
status (Kate Farms, 2018).
• “Tastes” better (when burped); less
retching/gagging (J Par Ent Nutr).
• Increased interest in home blenderized
foods using high quality blender; shared
meals, increased variety, lower cost,
improved tolerance. Importance of food
safety, contaminants, difficulty in
administration through tube, nutritional
planning. PBEN may be better option.
Photos and recipes by Sharon Palmer, MSFS, RDNConcerns: Nutritional Status for
Children on Plant-Based TF
• Long term pediatric use of plant-
based tube feedings prompts
nutrition concerns for growth and
development.
• Well-planned plant-based diets
(vegan, vegetarian) appropriate for
all ages and life cycles, including
infants and toddlers (AND, AAP).
• Over 30 years know that well-
planned vegan diets are
nutritionally adequate for growth
and development during early
years (JADA).
• Long history of plant-based diets
among children.
• Support family’s concerns and
desires with accurate information.
Farmers market produce
Photos and recipes by Sharon Palmer, MSFS, RDNPlant-Based Benefits For Children
• Research shows kids on plant-
based diets have lower risks of
obesity, heart disease, type 2
diabetes, hypertension, cancer
and other conditions (Eur J Nutr)
• Compared with nonvegetarians,
vegetarian children leaner, and
BMI difference becomes greater
during adolescence
(Am J Clin Nutr).
• Diets low in energy density, high
in complex carbs, fiber, water, Nicholas eating a plant-based diet.
which may increase satiety and
resting energy expenditure
(Am J Clin Nutr).
• Vegetarian children consume
more nutrients, i.e., vitamins A,
C, and folate, fiber and iron than
non-vegetarians (JADA).
Photos and recipes by Sharon Palmer, MSFS, RDNPlant-Based Nutrient Needs for Children
Vegan children meet or • Iron: Children on vegan diets do not
exceed recommendations experience anemia; but increased iron needs
for most nutrients and have due to bioavailability (vitamin C can enhance).
higher intakes of fiber, • Zinc: Deficiency rare in vegans; found in soy,
lower intakes of fat, legumes, nuts.
saturated fat, cholesterol. • Calcium: May be of concern among vegan
Yet, nutrients of concern: children; supplementation, consumption of
• Protein: Plant foods plant sources (soy, low-oxalate greens) key.
can provide all essential • Fat: Lower fat intake impact on growth is
amino acids; no need to negligible. Important to get ALA for
complement proteins at conversion to EPA, DHA or microalgae
same feeding. supplements.
• Vitamin B12: Intake essential (5 – 50
mcg/day, depending on age).
• Vitamin D: Should be supplemented, in
addition to sun exposure 20-30 min three
times/week (depending on skin, location).
• Iodine: Via iodized salt or supplements.
(Paediatr Child Health)
Farmers market Photos and recipes by Sharon Palmer, MSFS, RDNResearch on Plant-Based
Enteral Feedings (PBEN):
• PBEN improves health
of microbiota in
chronically ill children
(JPEN).
• Plant derivatives in
enteral nutrition may
help reduce side effects
and improve immune
response, per
preliminary research
(Univ Wisconsin).
• Need more research to Strawberries at farmers market
fully understand
benefits and risks.
Photos and recipes by Sharon Palmer, MSFS, RDNThank You!
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Photos and recipes by Sharon Palmer, MSFS, RDNQuestions
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